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Perry M, Mardin K, Chamberlin G, Busey EA, Taillie LS, Dillman Carpentier FR, Popkin BM. National Policies to Limit Food Marketing and Competitive Food Sales in Schools: A Global Scoping Review. Adv Nutr 2024; 15:100254. [PMID: 38876396 PMCID: PMC11295572 DOI: 10.1016/j.advnut.2024.100254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/20/2024] [Accepted: 06/07/2024] [Indexed: 06/16/2024] Open
Abstract
School food environments contribute to children's nutritional intake and overall health. As such, the World Health Organization and other public health organizations encourage policies that restrict children's access and exposure to foods and beverages that do not build health in and around schools. This global scoping review explores the presence and characteristics of policies that restrict competitive food sales and marketing for unhealthy foods across 193 countries using evidence from policy databases, gray literature, peer-reviewed literature, and primary policy documents. Policies were included if they were nationally mandated and regulated marketing and/or competitive foods in the school environments. Worldwide, only 28% of countries were found to have any national-level policy restricting food marketing or competitive food sales in schools: 16% of countries restrict marketing, 25% restrict competitive foods, and 12% restrict both. Over half of policies were found in high-income countries. No low-income countries had either policy type. Eight marketing policies (27%) and 14 competitive foods policies (29%) lacked explicit guidelines for either policy monitoring or enforcement. Future research is needed to assess the prevalence of policies aimed at improving other key aspects of the school food environment, such as dietary quality of school meals or food procurement, as well as assess the implementation and efficacy of existing policies.
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Affiliation(s)
- Michelle Perry
- Global Food Research Program, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Kayla Mardin
- Global Food Research Program, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Grace Chamberlin
- Global Food Research Program, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Health Policy, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Emily A Busey
- Global Food Research Program, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lindsey Smith Taillie
- Global Food Research Program, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Francesca R Dillman Carpentier
- Global Food Research Program, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Barry M Popkin
- Global Food Research Program, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
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Watson D, Barker M, Boua PR, Chatio S, Compaoré A, Danis M, Dalaba M, Erzse A, Hardy-Johnson P, Kehoe SH, Hofman KJ, Lawrence WT, Nonterah EA, Sorgho H, Rwafa-Ponela T, Ward KA, Tugendhaft A. What works in engaging communities? Prioritising nutrition interventions in Burkina Faso, Ghana and South Africa. PLoS One 2023; 18:e0294410. [PMID: 38091334 PMCID: PMC10718458 DOI: 10.1371/journal.pone.0294410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND "Choosing All Together" (CHAT), is a community engagement tool designed to give the public a voice in how best to allocate limited resources to improve population health. This process evaluation explored the mechanisms through which CHAT generates community engagement. METHOD The CHAT tool was adapted and implemented for use in two rural communities (Nanoro, Burkina Faso, and Navrongo, Ghana) and one urban township (Soweto, South Africa) to prioritize maternal and child nutrition interventions. Community discussions were audio-recorded, transcribed, and translated into English. Twenty-two transcripts, including six each from Navrongo and Soweto and 10 from Nanoro, were analysed thematically to generate data driven codes and themes to explain mechanisms underlying the CHAT process. The process evaluation was based on the UK MRC process evaluation guidance. RESULTS Seven themes describing the functions and outcomes of CHAT were identified. Themes described participants deliberating trade-offs, working together, agreeing on priorities, having a shared vision, and increasing their knowledge, also the skills of the facilitator, and a process of power sharing between participants and researchers. Participants came to an agreement of priorities when they had a shared vision. Trained facilitators are important to facilitate meaningful discussion between participants and those with lower levels of literacy to participate fully. CONCLUSION CHAT has been shown to be adaptable and useful in prioritising maternal and child nutrition interventions in communities in Burkina Faso, Ghana, and South Africa. Conducting CHAT in communities over a longer period and involving policy-makers would increase trust, mutual respect and develop partnerships.
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Affiliation(s)
- Daniella Watson
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health and Social Medicine, King’s College London, London, United Kingdom
| | - Mary Barker
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- School of Health Sciences, Faculty of Environment and Life Sciences, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - P. Romuald Boua
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Samuel Chatio
- Navrongo Health Research Centre, Ghana Health Service, Accra, Ghana
| | - Adelaide Compaoré
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Marion Danis
- Department of Bioethics, National Institutes of Health, Bethesda, MD, United States of America
| | - Maxwell Dalaba
- Navrongo Health Research Centre, Ghana Health Service, Accra, Ghana
- Institute of Heath Research, University of Health and Allied Sciences, Ho, Ghana
| | - Agnes Erzse
- SAMRC/Wits Centre for Health Economics and Decision Science—PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Polly Hardy-Johnson
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
| | - Sarah H. Kehoe
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
| | - Karen J. Hofman
- SAMRC/Wits Centre for Health Economics and Decision Science—PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Wendy T. Lawrence
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Engelbert A. Nonterah
- Navrongo Health Research Centre, Ghana Health Service, Accra, Ghana
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Hermann Sorgho
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Teurai Rwafa-Ponela
- SAMRC/Wits Centre for Health Economics and Decision Science—PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Kate A. Ward
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Aviva Tugendhaft
- SAMRC/Wits Centre for Health Economics and Decision Science—PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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Raphadu TT, Mphekgwana PM, Matshipi M, Monyeki KD. A Longitudinal Investigation on the Effects of Sodium and Potassium Intake on the Development of Hypertension and Abdominal Obesity from Childhood to Young Adulthood amongst Ellisras Rural Population, South Africa. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1330. [PMID: 37628329 PMCID: PMC10453195 DOI: 10.3390/children10081330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/26/2023] [Accepted: 07/29/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Hypertension (HT) and obesity have both been on the rise in children. Each is associated with an increase in cardiovascular disease risk, and both track into adulthood. OBJECTIVES This study aimed to identify the association of sodium intake (Na), potassium (K) intake, and sodium-to-potassium (Na/K) ratio with the development of HT and abdominal obesity amongst the Ellisras rural population over time. METHODS In this longitudinal study, data on dietary intake of Na and K were collected using a 24 h recall questionnaire from a total of 325 participants tracked from 1999 (5-12 years), 2001 (7-14 years), and 2015 (18-30 years). The averages of Na and K intake were analysed using local food tables and the South African Food Composition Database System (SAFOODS). In addition, blood pressure (BP) and anthropometric measurements (waist circumference (WC) and height) were also examined. Parametric (independent t-test) and Chi-square/Fishers exact tests were conducted to determine the difference between the years for numerical data and categorical variables. A generalised estimating equation (GEE) was used to assess the association of Na intake, K intake and their ratio on BP, WC, and waist-to-height ratio (WHtR). RESULTS Our results indicate a significant positive association between K intake and WHtR, and even though the model was adjusted for age and sex, there was still an association with WHtR. The Na/K ratio was associated with both BP measurements and abdominal obesity, respectively. Furthermore, Na/K was shown to be associated with an increased risk of developing HT and abdominal obesity. CONCLUSIONS In our study, we observed that an increase in the Na/K ratio is a predictor of HT and abdominal obesity over time compared to Na and K alone. However, more studies are required to further prove this.
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Affiliation(s)
- Thato Tshepo Raphadu
- Department of Physiology and Environmental Health, University of Limpopo, Sovenga 0727, South Africa; (T.T.R.); (M.M.)
| | - Peter Modupi Mphekgwana
- Department of Research Administration and Development, University of Limpopo, Sovenga 0727, South Africa;
| | - Moloko Matshipi
- Department of Physiology and Environmental Health, University of Limpopo, Sovenga 0727, South Africa; (T.T.R.); (M.M.)
| | - Kotsedi Daniel Monyeki
- Department of Physiology and Environmental Health, University of Limpopo, Sovenga 0727, South Africa; (T.T.R.); (M.M.)
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Cechin L, Norcross C, Oliveira A, Hopkins D, McGowan B, Post FA. Obesity and diabetes in people of African ancestry with HIV. HIV Med 2022; 24:380-388. [PMID: 36196017 DOI: 10.1111/hiv.13413] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 09/12/2022] [Indexed: 11/30/2022]
Abstract
Obesity is a chronic disease with multiple adverse effects on health. The prevalence of obesity is increasing worldwide, and people of African ancestry are disproportionally affected. Several widely used antiretrovirals have been associated with weight gain and contribute to the rising burden of obesity in people with HIV. Obesity and weight gain on antiretroviral therapy are risk factors for the development of type 2 diabetes mellitus, a condition which also disproportionally affects black populations. In this review, we discuss recent data on weight gain in relation to initiating or switching antiretroviral therapy and advances in the management of obesity. Availability of highly effective treatments for obesity have the potential to address, and potentially reverse, the epidemics of obesity and diabetes mellitus in people with HIV.
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Affiliation(s)
- Laura Cechin
- King's College Hospital NHS Foundation Trust, London, UK
| | - Claire Norcross
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | | | - David Hopkins
- King's College Hospital NHS Foundation Trust, London, UK.,Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, UK
| | - Barbara McGowan
- Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, UK.,Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Frank A Post
- King's College Hospital NHS Foundation Trust, London, UK
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5
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Finlay A, Robinson E, Jones A, Maden M, Cerny C, Muc M, Evans R, Makin H, Boyland E. A scoping review of outdoor food marketing: exposure, power and impacts on eating behaviour and health. BMC Public Health 2022; 22:1431. [PMID: 35896996 PMCID: PMC9330687 DOI: 10.1186/s12889-022-13784-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 07/12/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There is convincing evidence that unhealthy food marketing is extensive on television and in digital media, uses powerful persuasive techniques, and impacts dietary choices and consumption, particularly in children. It is less clear whether this is also the case for outdoor food marketing. This review (i) identifies common criteria used to define outdoor food marketing, (ii) summarises research methodologies used, (iii) identifies available evidence on the exposure, power (i.e. persuasive creative strategies within marketing) and impact of outdoor food marketing on behaviour and health and (iv) identifies knowledge gaps and directions for future research. METHODS A systematic search was conducted of Medline (Ovid), Scopus, Science Direct, Proquest, PsycINFO, CINAHL, PubMed, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials and a number of grey literature sources. Titles and abstracts were screened by one researcher. Relevant full texts were independently checked by two researchers against eligibility criteria. RESULTS Fifty-three studies were conducted across twenty-one countries. The majority of studies (n = 39) were conducted in high-income countries. All measured the extent of exposure to outdoor food marketing, twelve also assessed power and three measured impact on behavioural or health outcomes. Criteria used to define outdoor food marketing and methodologies adopted were highly variable across studies. Almost a quarter of advertisements across all studies were for food (mean of 22.1%) and the majority of advertised foods were unhealthy (mean of 63%). The evidence on differences in exposure by SES is heterogenous, which makes it difficult to draw conclusions, however the research suggests that ethnic minority groups have a higher likelihood of exposure to food marketing outdoors. The most frequent persuasive creative strategies were premium offers and use of characters. There was limited evidence on the relationship between exposure to outdoor food marketing and eating behaviour or health outcomes. CONCLUSIONS This review highlights the extent of unhealthy outdoor food marketing globally and the powerful methods used within this marketing. There is a need for consistency in defining and measuring outdoor food marketing to enable comparison across time and place. Future research should attempt to measure direct impacts on behaviour and health.
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Affiliation(s)
- Amy Finlay
- Department of Psychology, University of Liverpool, Liverpool, L69 7ZA, UK.
| | - Eric Robinson
- Department of Psychology, University of Liverpool, Liverpool, L69 7ZA, UK
| | - Andrew Jones
- Department of Psychology, University of Liverpool, Liverpool, L69 7ZA, UK
| | - Michelle Maden
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, L69 3GB, UK
| | - Caroline Cerny
- Department of Psychology, University of Liverpool, Liverpool, L69 7ZA, UK
- Obesity Health Alliance, Liverpool, UK
| | - Magdalena Muc
- Department of Psychology, University of Liverpool, Liverpool, L69 7ZA, UK
| | - Rebecca Evans
- Department of Psychology, University of Liverpool, Liverpool, L69 7ZA, UK
| | - Harriet Makin
- Department of Psychology, University of Liverpool, Liverpool, L69 7ZA, UK
| | - Emma Boyland
- Department of Psychology, University of Liverpool, Liverpool, L69 7ZA, UK
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6
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Mchiza ZJR. Diet Therapy and Public Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8312. [PMID: 35886174 PMCID: PMC9321782 DOI: 10.3390/ijerph19148312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 02/05/2023]
Abstract
A major threat to the achievement of the Sustainable Development Goals and Universal Health Coverage continues to be malnutrition [...].
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Affiliation(s)
- Zandile June-Rose Mchiza
- Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town 7505, South Africa; or ; Tel.: +27-21-938-0673
- School of Public Health, University of the Western Cape, Bellville 7535, South Africa
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Turner C, Bhogadi S, Walls H, Surendran S, Kulkarni B, Kinra S, Kadiyala S. Drivers of food acquisition practices in the food environment of peri-urban Hyderabad, India: A qualitative investigation. Health Place 2022; 74:102763. [DOI: 10.1016/j.healthplace.2022.102763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/21/2022] [Accepted: 02/03/2022] [Indexed: 11/04/2022]
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Carducci B, Oh C, Roth DE, Neufeld LM, Frongillo EA, L'Abbe MR, Fanzo J, Herforth A, Sellen DW, Bhutta ZA. Gaps and priorities in assessment of food environments for children and adolescents in low- and middle-income countries. NATURE FOOD 2021; 2:396-403. [PMID: 37118231 DOI: 10.1038/s43016-021-00299-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 05/06/2021] [Indexed: 04/30/2023]
Abstract
School-aged children and adolescents have complex interactions with their food environments-the point of engagement of individuals with the food system-and are influenced by a diversity of individual, household and organizational factors. Although a wide range of methods have been proposed to define, monitor and evaluate food environments, few are tailored to school-aged children and adolescents. Here, we interrogate published literature on food metrics and methodologies for the characterization of food environments for school-aged children and adolescents living in low- and middle-income counties. We identify key priority actions and potential indicators for better monitoring and evaluation to galvanize policymaking to improve the healthiness of these interactions, which are so crucial to future adult well-being.
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Affiliation(s)
- Bianca Carducci
- Centre for Global Child Health, Peter Gilgan Centre for Research, Learning Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Christina Oh
- Centre for Global Child Health, Peter Gilgan Centre for Research, Learning Hospital for Sick Children, Toronto, Ontario, Canada
| | - Daniel E Roth
- Centre for Global Child Health, Peter Gilgan Centre for Research, Learning Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public, Health University of Toronto, Toronto, Ontario, Canada
- Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, Ontario, Canada
| | | | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Mary R L'Abbe
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, Ontario, Canada
| | - Jessica Fanzo
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
- Johns Hopkins Nitze School of Advanced International Studies, Johns Hopkins University, Washington DC, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anna Herforth
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Daniel W Sellen
- Centre for Global Child Health, Peter Gilgan Centre for Research, Learning Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, Ontario, Canada
- Department of Anthropology, University of Toronto, Toronto, Ontario, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Peter Gilgan Centre for Research, Learning Hospital for Sick Children, Toronto, Ontario, Canada.
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
- Dalla Lana School of Public, Health University of Toronto, Toronto, Ontario, Canada.
- Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, Ontario, Canada.
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Institute for Global Health and Development, Aga Khan University, Karachi, Pakistan.
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Bosire EN, Cele L, Potelwa X, Cho A, Mendenhall E. God, Church water and spirituality: Perspectives on health and healing in Soweto, South Africa. Glob Public Health 2021; 17:1172-1185. [PMID: 33905311 DOI: 10.1080/17441692.2021.1919738] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Faith, belief, and religion can powerfully shape how people live with and heal from illness. Engaging in religious practices, from gathering for services to reading the holy texts and engaging in private prayer, can serve as a critical way of coping or building resilience amidst everyday social, moral, and medical challenges. In this article, we investigate why, what, and how people living with chronic illness in an urban South African township prioritise healing practices of the Church over the Clinic. We conducted 88 in-depth qualitative interviews to understand how people think about health, chronic illness, and healing. Most people described complex socio-spiritual beliefs and practices that many prioritised or practiced apart from biomedical care. This included religious practices, such as prayer and drinking church water, as well as one's spirituality, which was an essential way in which people found healing. Recognising how socio-spiritual practice fosters healing and wellness is critical for thinking about health and healing for Soweto residents.
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Affiliation(s)
- Edna N Bosire
- SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lindile Cele
- SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Xola Potelwa
- SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Health Sciences, University of York, York, UK
| | - Allison Cho
- Edmund A. Walsh School of Foreign Service, Georgetown University, Washington, DC, USA
| | - Emily Mendenhall
- SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Edmund A. Walsh School of Foreign Service, Georgetown University, Washington, DC, USA
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10
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Erzse A, Christofides N, Stacey N, Lebard K, Foley L, Hofman K. Availability and advertising of sugar sweetened beverages in South African public primary schools following a voluntary pledge by a major beverage company: a mixed methods study. Glob Health Action 2021; 14:1898130. [PMID: 33910480 PMCID: PMC8288764 DOI: 10.1080/16549716.2021.1898130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/28/2021] [Indexed: 10/31/2022] Open
Abstract
Background: Towards the end of the 2017 school year, a prominent beverage company in South Africa pledged to remove their sugar-sweetened beverages (SSBs) and advertisements from primary schools in order to contribute to the realization of a healthy school environment.Objectives: To assess the availability and advertising of the company's beverages in public primary schools in Gauteng province following their voluntary pledge to remove the products, and to explore perceptions of school staff regarding SSB availability in schools and processes related to the implementation of the pledge.Methods: In 2019, we conducted a representative survey of public sector primary (elementary) schools in Gauteng province, South Africa. A random sample of schools was drawn, with schools stratified by whether or not they charge fees. This was a proxy for the socioeconomic status of the locale and student body. At each school, the availability of beverages and presence of advertising or not was assessed by an observational audit tool and differences across fee status assessed by Pearson χ 2 test. Semi-structured interviews were conducted with a purposive sample of school officials. Data from the interviews were coded and thematic analysis conducted.Results: Two years following a voluntary pledge, the company's carbonated SSBs were available for sale in 54% (CI: 45-63%) of schools with tuck shops and advertised in 31% (CI: 25-39%). Qualitative interviews revealed a complex landscape of actors within schools, which, combined with indifference or resistance to the pledge, may have contributed to the continued availability of SSBs.Conclusions: Though we were unable to examine SSB availability before and after the pledge, our findings provide some preliminary evidence that voluntary pledges by commercial entities are not sufficient to remove SSBs and advertisements from schools. Mandatory regulations coupled with in-depth engagement with schools may be an avenue to pursue in the future.
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Affiliation(s)
- Agnes Erzse
- SAMRC/Centre for Health Economics and Decision Science, PRICELESS, Faculty of Health Sciences, University of Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Nicola Christofides
- Faculty of Health Sciences, University of Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Nicholas Stacey
- SAMRC/Centre for Health Economics and Decision Science, PRICELESS, Faculty of Health Sciences, University of Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Kelsey Lebard
- SAMRC/Centre for Health Economics and Decision Science, PRICELESS, Faculty of Health Sciences, University of Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Louise Foley
- MRC Epidemiology Unit, University of Cambridge, UK
| | - Karen Hofman
- SAMRC/Centre for Health Economics and Decision Science, PRICELESS, Faculty of Health Sciences, University of Witwatersrand School of Public Health, Johannesburg, South Africa
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11
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Sousa S, Gelormini M, Damasceno A, Moreira P, Lunet N, Padrão P. Billboard food advertising in Maputo, Mozambique: a sign of nutrition transition. J Public Health (Oxf) 2020; 42:e105-e106. [PMID: 31329934 DOI: 10.1093/pubmed/fdz041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/11/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sofia Sousa
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal.,EPI Unit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Marcello Gelormini
- Agência Italiana Para a Cooperação e Desenvolvimento, Maputo, Mozambique
| | - Albertino Damasceno
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique.,Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Pedro Moreira
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal.,EPI Unit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Nuno Lunet
- EPI Unit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Patrícia Padrão
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal.,EPI Unit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
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Molete M, Stewart A, Bosire E, Igumbor J. The policy implementation gap of school oral health programmes in Tshwane, South Africa: a qualitative case study. BMC Health Serv Res 2020; 20:338. [PMID: 32316953 PMCID: PMC7171775 DOI: 10.1186/s12913-020-05122-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 03/18/2020] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND School going children across the world continue to experience high levels of untreated dental diseases. The South African Oral Health policy documents present measures to address the oral health needs of children in school settings, yet the burden of oral disease in the country is over 50% among primary school children. METHODS Our study therefore sought to assess the implementation of school oral health programmes in Tshwane in line with policy recommendations using the Walt & Gilson policy analysis triangle. A qualitative explanatory case study was undertaken using a combination of data from direct observations and interviews. The case analysis involved assessing the processes of providing school oral health programmes that were offered at 10 schools in Tshwane. The measuring tools included process maps and an interview guide. RESULTS The results found that policy implementation was affected by poor prior planning, inadequate resources, poor school infrastructure and lack of support from key stakeholders. Furthermore, inconsistencies in policy interpretation by management, coupled with the fact that the oral hygienists were not conversant with the policy hampered delivery of the policy content. The variations in policy implementation observed were often at the discretion of the oral hygienist in response to contextual challenges. CONCLUSION There was policy and practice misalignment and variations in the processes of implementing oral health programmes across the 10 schools. Hence regular monitoring, evaluation and root cause analysis is recommended for such programmes in order to make informed decisions on contextually relevant and standardised programme modifications.
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Affiliation(s)
- Mpho Molete
- Department of Community Dentistry, University of the Witwatersrand, School of Oral Health Sciences, 7 York Road, Parktown, Johannesburg, 2193, South Africa.
| | - Aimee Stewart
- University of the Witwatersrand, School of Therapeutic Sciences, Johannesburg, South Africa
| | - Edna Bosire
- School of Cinical Medicine, University of the Witwatersrand, Development Pathways for Health Research Unit (DPHRU), Johannesburg, South Africa
| | - Jude Igumbor
- University of the Witwatersrand, School of Public Health, Johannesburg, South Africa
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Abstract
OBJECTIVE In the past decade, South Africa's obesity epidemic has increased in both children and adults, and being overweight is becoming the norm. Several contributing factors lead to the normalisation of obesity. One of these is the culturally entrenched likeness of larger body sizes or shapes within a milieu of easily accessible unhealthy food and beverages. This qualitative study advances knowledge about the influence of socio-cultural norms and obesogenic environments on weight under estimation and 'obesity normalisation' amongst black South Africans living in an urban setting. DESIGN A theory-based qualitative study used focus group discussions (FGDs) with a semi-structured interview guide. FGDs were transcribed verbatim and analysed thematically using a constant comparison method. SETTING Soweto, Johannesburg, South Africa, is a setting which has undergone rapid urbanisation and nutrition transition with ubiquitous availability of processed and fast-foods. PARTICIPANTS Adults older than 18 years living in Soweto (n 57). RESULTS There is a wide misperception about obesity amongst black Africans living in an urban setting in Soweto. Participants who admitted to being fat or overweight did not view themselves as such. This could be attributed to unchanging socio-cultural factors that reinforce the acceptability of bigger bodies and living in obesogenic environment. CONCLUSIONS Without addressing socio-cultural norms that attribute bigger bodies to beauty and wealth, motivating individuals to address weight gain will prove difficult especially for populations living in obesogenic environments. A multi-faceted strategy is required to address obesity in urban South African settings.
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Turner C, Kalamatianou S, Drewnowski A, Kulkarni B, Kinra S, Kadiyala S. Food Environment Research in Low- and Middle-Income Countries: A Systematic Scoping Review. Adv Nutr 2020; 11:387-397. [PMID: 31079142 PMCID: PMC7442349 DOI: 10.1093/advances/nmz031] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/22/2019] [Accepted: 03/07/2019] [Indexed: 11/13/2022] Open
Abstract
Food environment research is increasingly gaining prominence in low- and middle-income countries (LMICs). However, in the absence of a systematic review of the literature, little is known about the emerging body of evidence from these settings. This systematic scoping review aims to address this gap. A systematic search of 6 databases was conducted in December 2017 and retrieved 920 records. In total, 70 peer-reviewed articles met the eligibility criteria and were included. Collectively, articles spanned 22 LMICs, including upper-middle-income countries (n = 49, 70%) and lower-middle-income countries (n = 18, 26%). No articles included low-income countries. Articles featured quantitative (n = 45, 64%), qualitative (n = 17, 24%), and mixed-method designs (n = 11, 8%). Studies analyzed the food environment at national, community, school, and household scales. Twenty-three articles (55%) assessed associations between food environment exposures and outcomes of interest, including diets (n = 14), nutrition status (n = 13), and health (n = 1). Food availability was associated with dietary outcomes at the community and school scales across multiple LMICs, although associations varied by vendor type. Evidence regarding associations between the food environment and nutrition and health outcomes was inconclusive. The paucity of evidence from high-quality studies is a severe limitation, highlighting the critical need for improved study designs and standardized methods and metrics. Future food environment research must address low-income and lower-middle-income countries, and include the full spectrum of dietary, nutrition, and health outcomes. Improving the quality of food environment research will be critical to the design of feasible, appropriate, and effective interventions to improve public health nutrition in LMICs.
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Affiliation(s)
- Christopher Turner
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, Department of Population Health, London, United Kingdom
| | - Sofia Kalamatianou
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, Department of Population Health, London, United Kingdom
| | - Adam Drewnowski
- University of Washington, Department of Nutritional Sciences, Center for Public Health Nutrition, Seattle, WA
| | - Bharati Kulkarni
- National Institute of Nutrition, Tarnaka, Hyderabad, Telangana, India
| | - Sanjay Kinra
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, Department of Population Health, London, United Kingdom
| | - Suneetha Kadiyala
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, Department of Population Health, London, United Kingdom
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Overlapping spatial clusters of sugar-sweetened beverage intake and body mass index in Geneva state, Switzerland. Nutr Diabetes 2019; 9:35. [PMID: 31727876 PMCID: PMC6856345 DOI: 10.1038/s41387-019-0102-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 10/21/2019] [Accepted: 10/21/2019] [Indexed: 01/01/2023] Open
Abstract
Background Obesity and obesity-related diseases represent a major public health concern. Recently, studies have substantiated the role of sugar-sweetened beverages (SSBs) consumption in the development of these diseases. The fine identification of populations and areas in need for public health intervention remains challenging. This study investigates the existence of spatial clustering of SSB intake frequency (SSB-IF) and body mass index (BMI), and their potential spatial overlap in a population of adults of the state of Geneva using a fine-scale geospatial approach. Methods We used data on self-reported SSB-IF and measured BMI from residents aged between 20 and 74 years of the state of Geneva (Switzerland) that participated in the Bus Santé cross-sectional population-based study (n = 15,423). Getis-Ord Gi spatial indices were used to identify spatial clusters of SSB-IF and BMI in unadjusted models and models adjusted for individual covariates (education level, gender, age, nationality, and neighborhood-level median income). Results We identified a significant spatial clustering of BMI and SSB-IF. 13.2% (n = 2034) of the participants were within clusters of higher SSB-IF and 10.7% (n = 1651) were within clusters of lower SSB-IF. We identified overlapping clusters of SSB-IF and BMI in specific areas where 11.1% (n = 1719) of the participants resided. After adjustment, the identified clusters persisted and were only slightly attenuated indicating that additional neighborhood-level determinants influence the spatial distribution of SSB-IF and BMI. Conclusions Our fine-scale spatial approach allowed to identify specific populations and areas presenting higher SSB-IF and highlighted the existence of an overlap between populations and areas of higher SSB-IF associated with higher BMI. These findings could guide policymakers to develop locally tailored interventions such as targeted prevention campaigns and pave the way for precision public health delivery.
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Age and gender influence healthy eating and physical activity behaviours in South African adolescents and their caregivers: Transforming Adolescent Lives through Nutrition Initiative (TALENT). Public Health Nutr 2019; 24:5187-5206. [DOI: 10.1017/s1368980019002829] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Abstract
Objective:
To: (i) understand facilitators and barriers to healthy eating practices and physical activity in younger and older urban adolescent South African boys and girls; and (ii) understand how the views of caregivers interact with, and influence, adolescent behaviours.
Design:
Semi-structured focus group discussions (FGD) were conducted in July 2018. Data were analysed using thematic analysis.
Setting:
Soweto, Johannesburg, South Africa.
Participants:
Seventy-five participants were stratified into eight FGD as follows: two for young boys and girls (10–12 years); two for older boys and girls (15–17 years); two for caregivers of young adolescents (boys and girls); and two for caregivers of older adolescents (boys and girls).
Results:
Unlike their caregivers, adolescents were not motivated to eat healthily and failed to appreciate the need to develop consistent patterns of both healthy eating and physical activity for their long-term health. Although adolescents gained independence with age, they commonly attributed unhealthy food choices to a lack of autonomy and, thereby, to the influence of their caregivers. Adolescents and caregivers perceived their engagement in physical activity according to distinct siloes of recreational and routine activity, respectively. Both similarities and differences in the drivers of healthy eating and physical activity exist in adolescents and caregivers, and should be targeted in future interventions.
Conclusions:
Our study identified a complex paradigm of eating practices and physical activity in South African adolescents and their caregivers. We also highlighted the need for a new narrative in addressing the multifaceted and interrelated determinants of adolescent health within urban poor settings.
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Pengpid S, Peltzer K. Prevalence and socio-behavioral factors associated with sugar-sweetened beverages consumption among 15 years and older persons in South Africa. Diabetes Metab Syndr Obes 2019; 12:937-945. [PMID: 31417294 PMCID: PMC6594001 DOI: 10.2147/dmso.s209147] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 05/07/2019] [Indexed: 11/23/2022] Open
Abstract
Objective: The aim of this study was to assess the frequency of sugar-sweetened beverages (SSB) consumption and its relationship with socio-behavioral factors using national population-based data in South Africa. Subjects and methods: Cross-sectional data were analyzed from the South African National Health and Nutrition Examination Survey (SANHANES-1) in 2012. The population sample included 15,179 adults (median age=34.0 years, interquartile range=25, range=15-98 years) who participated in the SANHANES-1. Results: Overall, the study participants consumed 33.9% none, 48.3% 1-3 times, 7.2% 4-6 times, and 10.6% every day soft drinks in the past week (or an equivalent of an average of 0.30 servings, SD=0.3, per day); 43.4% had consumed no sweetened fruit juice, 42.3% 1-3 times, 5.2% 4-6 times; and 9.1% daily sweetened fruit juice (or an equivalent of an average of 0.25 servings, SD=0.3, per day). The prevalence of daily SSB (soft drink and/or sweetened fruit juice) consumption was 16.0% (or an equivalent of an average of 0.54 servings, SD=0.5, per day). In the final logistic regression model, younger age, urban residence, perceived overweight, fruit consumption, fresh fruit juice consumption, and having had processed meat and fried food from street vendors were associated with SSB consumption. In addition, problem drinking and physical activity were associated with daily soft drink consumption, and higher sedentary time was associated with daily sweetened fruit juice consumption. Conclusions: The study found a high prevalence of daily SSB consumption and identified several socio-behavioral factors that can be targeted in public health intervention programs.
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Affiliation(s)
- Supa Pengpid
- ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhonpathom, Thailand
- Research and Innovation Office, North West University, Potchefstroom, South Africa
| | - Karl Peltzer
- Research and Innovation Office, North West University, Potchefstroom, South Africa
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Wagner RG, Crowther NJ, Gómez-Olivé FX, Kabudula C, Kahn K, Mhembere M, Myakayaka Z, Tollman S, Wade AN. Sociodemographic, socioeconomic, clinical and behavioural predictors of body mass index vary by sex in rural South African adults-findings from the AWI-Gen study. Glob Health Action 2019; 11:1549436. [PMID: 30499746 PMCID: PMC6282437 DOI: 10.1080/16549716.2018.1549436] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background: Despite increasing obesity in South African adults, data on the prevalence and determinants of body mass index (BMI) from rural communities, home to a significant proportion of the population, are scarce. Objectives: To investigate overall and sex-specific determinants of BMI in a rural adult South African population undergoing rapid social and epidemiological transitions. Methods: Baseline cross-sectional demographic, socioeconomic, anthropometric, clinical and behavioural data were collected between 2015 and 2016 from 1388 individuals aged 40–60 years and resident in the Agincourt sub-district of Mpumalanga province, a setting typical of rural northeast South Africa. A Health and Socio-Demographic Surveillance System (HDSS) underpins the sub-district and contributes to the Africa Wits-INDEPTH partnership for Genomic Studies (AWI-Gen). Linear regression was used to investigate univariate associations between log-transformed BMI and individual variables and multiple linear regression was used to investigate independent predictors of BMI overall and in sex-stratified analyses. Results: Median BMI was significantly higher in females (28.7 kg/m2[95% CI 24.2–33.2] vs 23.0 kg/m2[95% CI 20.3–26.8];p < 0.001) with male sex associated with 17% lower BMI. In sex-stratified multiple linear regression models, compared to those never married, BMI was 7% higher in currently married males and 6% in currently married females. Current smoking in men and former smoking in women were associated with reductions in BMI of 13% and 26% respectively, compared with non-smokers. Higher educational attainment in women and higher socioeconomic status in men were both associated with higher BMI, while being HIV-positive and alcohol consumption in women were associated lower BMI. Conclusions: Female sex strongly predicts higher BMI in this rural African population. While some predictors of higher BMI differ by sex, married individuals in both sexes had a higher BMI, suggesting that, in addition to developing sex-specific interventions to combat overweight and obesity, targeting married couples may result in reduction in population BMI.
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Affiliation(s)
- Ryan G Wagner
- a MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa.,b Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
| | - Nigel J Crowther
- c Department of Chemical Pathology, National Health Laboratory Service and Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - F Xavier Gómez-Olivé
- a MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Chodziwadziwa Kabudula
- a MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Kathleen Kahn
- a MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa.,b Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden.,d INDEPTH Network , Accra , Ghana
| | - Memory Mhembere
- a MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Zola Myakayaka
- a MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Stephen Tollman
- a MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa.,b Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden.,d INDEPTH Network , Accra , Ghana
| | - Alisha N Wade
- a MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
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Attitudes and perceptions among urban South Africans towards sugar-sweetened beverages and taxation. Public Health Nutr 2019; 23:374-383. [PMID: 31179956 DOI: 10.1017/s1368980019001356] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE A tax on sugar-sweetened beverages (SSB) was introduced in South Africa in April 2018. Our objective was to document perceptions and attitudes among urban South Africans living in Soweto on factors that contribute to their SSB intake and on South Africa's use of a tax to reduce SSB consumption. DESIGN We conducted six focus group discussions using a semi-structured guide. SETTING The study was conducted in Soweto, Johannesburg, South Africa, 3 months before South Africa's SSB tax was implemented. PARTICIPANTS Adults aged 18 years or above living in Soweto (n 57). RESULTS Participants reported frequent SSB consumption and attributed this to habit, addiction, advertising and wide accessibility of SSB. Most of the participants were not aware of the proposed SSB tax; when made aware of the tax, their responses included both beliefs that it would and would not result in reduced SSB intake. However, participants indicated cynicism with regard to the government's stated motivation in introducing the tax for health rather than revenue reasons. CONCLUSIONS While an SSB tax is a policy tool that could be used with other strategies to reduce people's high level of SSB consumption in Soweto, our findings suggest a need to complement the SSB tax with a multipronged behaviour change strategy. This strategy could include both environmental and individual levers to reduce SSB consumption and its associated risks.
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Global public health starts at home: upstream approaches to global health training. LANCET GLOBAL HEALTH 2019; 7:e301-e302. [DOI: 10.1016/s2214-109x(18)30558-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 11/30/2018] [Indexed: 11/21/2022]
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Nutrient profile and energy cost of food sold by informal food vendors to learners in primary and secondary schools in the Eastern Cape, South Africa. Public Health Nutr 2018; 22:521-530. [PMID: 30585148 DOI: 10.1017/s1368980018003464] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To assess type, nutrient profile and cost of food items sold by informal vendors to learners; and to determine nutrient content of corn-based processed snacks frequently sold. DESIGN Cross-sectional survey. SETTING Quintile 1 to 3 schools (n 36) randomly selected from six education districts; Eastern Cape, South Africa.ParticipantsInformal food vendors (n 92) selling inside or immediately outside the school premises. RESULTS Food items sold at most schools were corn-based processed snacks (94 % of schools), sweets (89 %), lollipops (72 %) and biscuits (62 %). Based on the South African Nutrient Profiling model, none of these foods were profiled as healthy. Foods less commonly sold were fruits (28 % of schools) and animal-source foods; these foods were profiled as healthy. Mean (sd) energy cost (per 418 kJ (100 kcal)) was highest for animal-source foods (R2·95 (1·16)) and lowest for bread and vetkoek (R0·76 (0·21)), snacks (R0·76 (0·30)) and confectionery products (R0·70 (0·28)). The nutrient profiling score was inversely related to the energy cost of the food item (r = -0·562, P = 0·010). Compared with brand-name corn-based processed snacks, non-branded snacks had lower energy (2177 v. 2061 kJ; P = 0·031) content per 100 g. None of the brand-name samples contained sucrose; six of the nine non-branded samples contained sucrose, ranging from 4·4 to 6·2 g/100 g. CONCLUSIONS Foods mostly sold were unhealthy options, with the healthier food items being more expensive sources of energy.
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Abstract
OBJECTIVES This was a two-part descriptive study designed to (1) assess the marketing themes and sugar content of beverages promoted in outdoor advertisements (ads) within a portion of Accra, Ghana and (2) quantify the types of ads that appeared along the Accra-Cape Coast Highway. SETTING A 4.7 km2 area of Accra, Ghana and a 151 km region along the highway represented the target areas for collecting photos of outdoor beverage ads. PRIMARY AND SECONDARY OUTCOME MEASURES Number and types of beverage ads, sugar content of beverage products featured in ads and marketing themes used in ads. DESIGN Two researchers photographed outdoor beverage ads in a 4.7 km2 area of Accra and used content analysis to assess marketing themes of ads, including the portrayal of children, local culture, music, sports and health. Researchers also recorded the number and type of ads along a 151 km stretch of the Accra-Cape Coast Highway. Researchers assessed the added sugar content to determine which beverages were sugar-sweetened beverages (SSBs). RESULTS Seventy-seven photographed ads were analysed. Seventy-three per cent (72.7%) of ads featured SSBs, and Coca-Cola accounted for 59.7% of ads. Sixty-five per cent (64.9%) of all ads featured sodas, while 35.1% advertised energy drinks, bottled or canned juice drinks and coffee-based, milk-based and water-based beverages. Thirteen per cent (13%) of ads featured children and 5.2% were located near schools or playgrounds. Nine per cent (9.1%) of ads contained a reference to health and 7.8% contained a reference to fitness/strength/sport. Along the Accra-Cape Coast Highway, Coca-Cola accounted for 60% of branded ads. CONCLUSION This study demonstrates the frequency of outdoor SSB ads within a 4.7 km2 area of Accra, Ghana. Coca-Cola was featured in the majority of ads, and the child-targeted nature of some ads indicates a need to expand the Children's Food and Beverage Advertising Initiative pledge to reduce child-targeted marketing on a global scale.
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Affiliation(s)
- Marie A Bragg
- Department of Population Health, New York University School of Medicine, New York City, New York, USA
- Department of Public Health Nutrition, New York University College of Global Public Health, New York City, New York, USA
| | - Tamara Hardoby
- New York City Department of Health and Mental Hygiene, New York City, New York, USA
| | - Natasha G Pandit
- Department of Population Health, New York University School of Medicine, New York City, New York, USA
| | - Yemi R Raji
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Gbenga Ogedegbe
- Department of Population Health, New York University School of Medicine, New York City, New York, USA
- Section for Global Health, Division of Health and Behavior, Department of Population Health, New York University School of Medicine, New York City, New York, USA
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Nortje N, Faber M, de Villiers A. School tuck shops in South Africa—an ethical appraisal. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2017. [DOI: 10.1080/16070658.2017.1267401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Nico Nortje
- Department of Psychology, University of the Free State, Bloemfontein, South Africa
| | - Mieke Faber
- Department of Dietetics, University of the Western Cape; and Non-Communicable Diseases Research Unit, South African Medical Research Council, Bellville, South Africa
| | - Anniza de Villiers
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Bellville, South Africa
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von Philipsborn P, Stratil JM, Burns J, Busert LK, Pfadenhauer LM, Polus S, Holzapfel C, Hauner H, Rehfuess E. Environmental interventions to reduce the consumption of sugar-sweetened beverages and their effects on health. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012292] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Peter von Philipsborn
- Technical University Munich; Faculty of Medicine; Stuntzstrasse 12 81677 Munich Germany
| | - Jan M Stratil
- University of Tuebingen; Faculty of Medicine; Wilhelmstrasse 127 Tuebingen Germany 72076
| | - Jacob Burns
- Ludwig-Maximilians-University Munich; Institute for Medical Informatics, Biometry and Epidemiology; Marchioninistr. 15 Munich Bavaria Germany
| | - Laura K Busert
- Ludwig-Maximilians-University Munich; Institute for Medical Informatics, Biometry and Epidemiology; Marchioninistr. 15 Munich Bavaria Germany
| | - Lisa M Pfadenhauer
- Ludwig-Maximilians-University Munich; Institute for Medical Informatics, Biometry and Epidemiology; Marchioninistr. 15 Munich Bavaria Germany
| | - Stephanie Polus
- Ludwig-Maximilians-University Munich; Institute for Medical Informatics, Biometry and Epidemiology; Marchioninistr. 15 Munich Bavaria Germany
| | - Christina Holzapfel
- Technische Universität München Klinikum rechts der Isar; Institute for Nutritional Medicine; Munich Germany
| | - Hans Hauner
- Technische Universität München Klinikum rechts der Isar; Institute for Nutritional Medicine; Munich Germany
| | - Eva Rehfuess
- Ludwig-Maximilians-University Munich; Institute for Medical Informatics, Biometry and Epidemiology; Marchioninistr. 15 Munich Bavaria Germany
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Affiliation(s)
- James B Holt
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mail Stop F-78, Atlanta, GA 30341.
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